My father qualified as a GP in 1946. He often talked of medicine being as much an art as a science. Some of us remember Dr Finlay of Tannochbrae and his 1920s practice.
I am lucky to have a good GP, but he is popular and his wait time is often 3 or 4 weeks. This makes continuity of care more difficult in a ten doctor practice if you need to be seen sooner.
My impression of 5 practices over the last 20 years, is that the GPs concerned have perhaps been complicit in a progressive deskilling of their art. Perhaps this was always inevitable with the relentless onslaught of scientific and super-specialised medical practice.
Under the pressures of guidelines, protocols, audit, litigation and shorter appointment times, I wonder if some GPs see themselves less as gatekeepers and more as a conduit to the right specialist.
Nonetheless, I think we should on this forum avoid giving the impression that we should pressure our GP to refer us to an electrophysiologist, simply because we believe that GPs have insufficient knowledge of how to manage AFib
If we are very well informed, it may be that seeing an EP serves more purpose. But our GPs are much better placed to see us in the round, the whole person in the context of our domestic situation.
As in all specialties, the more we insist on seeing a specialist, the longer the waiting lists will grow.
If you happen to be lucky eneough to have a GP like Matt Fay then maybe. Other wise regardless of your rose tinted specs the plain facts are that GPs are general practitioners and cannot possibly know everything. The NICE guidelines are quite cleaar that if your GP is unable to satisfactorily deal with your arrhythmia then you have the right to see a specialist.
That may not be an EP in the first instance of course but do remember that legally GP s are quite limited n what treatments they can give these days.
Just as not all GPs are experts in a particular field, neither are all EPs experts in their own field. Mine showed little interest in anything beyond cardioversion, electrical or otherwise, and ablation. Ultimately they gave me contradictory advice about ablation, despite having adjacent offices.
It could take 9 months to see an NHS EP, even pre Covid. Immediate referral may result in loss of valuable time where GP and patient could be working collaboratively. In some cases, referral may not then be necessary. The electrophysiology lab is not always a golden panacea.
One answer may be to give GPs more opportunities to tap in to sources of information which are more user friendly than NICE guidelines which can be difficult to understand.
And yes, in my opinion, nothing should be said here which undermines the confidence of an individual member in their own GP or GPs generally.
Your comment they cannot know everything reminded me of one of my GPs. He told me I might need a Cardioversion. "They stick a wire into your heart to fix things" . The same one also took my pulse and told me I was in Afib but not symptomatic. The tiredness and difficult breathing must have been my imagination! . Needless to say I avoid this Gp now.
Very interesting thread and well written. You raise some excellent points. One thing I would question is...
"I think we should on this forum avoid giving the impression that we should pressure our GP to refer us to an electrophysiologist, simply because we believe that GPs have insufficient knowledge of how to manage AFib"
Personally I don't think many (some) GP's do have sufficient knowledge of afib. They are also unable to prescribe certain med's. Only an EP or cardio can do so.
Also...
"our GPs are much better placed to see us in the round, the whole person in the context of our domestic situation"
I agree if you can see the same GP every visit - however it's almost impossible to see the same doctor at the surgery I use (I'm sure it's the same for others). It's a different GP everytime. When I was a kid it was one doctor / one surgery but those days are over.
"But our GPs are much better placed to see us in the round"
That's hard to do these days - certainly when you see a different doctor on most visits. I fully respect your views but I think afibbers should ask their GP for a referral to see a cardio or EP.
That's my take. Enjoy your day Badger - interesting thread.
My EP is only interested in performing ablations, once I'd had three and still not been helped much by them he discharged me from his care. How I envy those whose EP's still see them regardless of them not even having had one ablation.
I agree with Badger and don't think we should rush to see an EP too soon. It always amazes me when I see people coming to the forum after one attack of AF and being advised to see one. I feel that diet should be the first thing that's addressed and we should direct them that way.
The longer I'm on this forum the more I see how different my outlook with regards to taking any form of medication is, compared to the majority of members here. Some long for a pill to cure them, me - I just don't trust them. They may help one thing, but cause damage elsewhere in our bodies.
How I wish I'd been better informed about diet before having my ablations.
I agree with much of what you say but as with most things, not every EP acts the same. In my case I was referred to an EP by my cardiologist who I was referred to by my GP on diagnosis, so I was extremely fortunate. I’m sure that isn’t the same for many. Even though my EP had notes from both the GP and cardiologist, he still went through my history and lifestyle before recommending an ablation. I guess it’s because AF is well known to be a progressive condition, specialists prefer to do their stuff sooner than later because they are likely to be more successful in their endeavours.
I still think that the change of diet route is the best way to start, but not consuming any artificial additives must be strictly adhered to. I guess we all speak as we find.
And I think it true to say Jean that we do tend to focus people on life style changes when they arrive here. I also say that there will always be racing snakes with AF so it doesn't always help.
SRM Grandma first mentioned this about seven years ago when she found a paper about less meat and more plant based diet and I have been mentioning this pretty much ever since. The LEGACY trials in Australia further advanced the knowledge regarding obesity and the effect on AF but is still relevant.
I remember being lectured by a couple I was friends with in the early 80s about my unhealthy butter eating ways and how some horrid tasting "spread" ( which they had started serving ) was the latest recommendation. I took no notice , never bought such rubbish and lo 30 years later it turns out that the nasty spread was all along the villain. I have also out lived her by 10 years.
I have had 13 attacks of afib since Oct 2014. 6 of these last year. My attacks never last more than 12 hours and have become less symptomatic. They do not cause the anxiety I had at first. I have been wondering if I shoud go back to my cardiologist and see about getting Flecainide as a PIP so as to shorten the episodes or if I should see an EP and think about an ablation. I had an echo before my hip op and my cardiologist said it was ok with an ejection fraction of just over 60%. I really don't want to take Flec. I react badly to pills on the whole and already hate having to take Apixaban and Nebivolol. I agree 100% with you that they damage our bodies. I also think women suffer more from obvious side effects than men do.
My PAF attacks always happened every 4-6 weeks. I knew I would never get by 6 weeks without having one. I hear so many people, mostly women say the same thing and wonder if our hormones are involved.
I guess you have tried the healthy diet, weight loss (if needed) routes. Stress too is a trigger for my AF and fortunately I have little of that these days. I've lived on my own for the last 6 years and my life is now so peaceful and worry free. I'm sure that helps.
I hope that you don't have to resort to having an ablation and by accepting your AF it will help to reduce your attacks. I really don't give my AF much thought these days, just can't be bothered with it and not so long ago if I ever did give it attention it would immediately get worse. Must admit that my being in constant AF now is a lot easier to cope with.
I have a healthy diet but am overweight. I do not eat very much but my activity levels have been much reduced over the last 18 months due to my hips. Even now I have to balance the walking necessary to help recovery with the right hip replacement against the pain in the left hip that will need to be replaced later this year. I think the big increase in attacks last year was partly due to the stress the hip pain was causing and not being able to do what I wanted ie garden for several hours a day! I managed a couple of hours yesterday but was punished by lots of pain in my legs at night! So far this year I have had only one afib episode - the first one where I have woke in the morning in afib. Part of the problem is that since they removed my T3 from my thyroid meds I have put on weight again. I am one of the people who just do not do that well on T4 alone. It was only once I started on T3 that I stopped piling on the weight that 7 years of undiagnosed hypo had caused - despite high activity levels. I do not try to lose weight anymore. I lost over half a stone when I had diverticulitis but it came back ( and more) with no change in diet or activity. I don't think the destruction of gut bacteria by antibiotics helped! I am hoping that when I get the second hip done I can restart my exercise bike. I tried it and the operated hip was fine which was great but not the left.
A friend of mine is in the same position as you, she had one hip replaced last year and hopes to have the other one done this year. Her muscles at the moment are not working as they should in the hip/leg that's been done, so she has to do a lot of exercises, but her consultant says this will help her and she'll be ok.
Are you able to source your own T3? I know that some members on the Thyroid UK forum do that.
Yes but I am afraid to try it again as I am worried it will spark off the afib. I have tried putting up my T4 but that seems to spark attacks . I have similar problems with the muscles ( they cut them during the surgery!) but one on top - the exercises the physio showed me hurt my already fragile tendons! My right knee has also been very painful since the op and became very swollen at first. It is slowly improving. Part of the problem is that my connective tissue is just so fragile because of the FQ toxicity. I have been pruning the wisteria that is trained along our upstairs terraces. This involves a fair amount of stretching and yesterday I came in and later realised I had pulled a muscle in my upper back. Many a time I've picked up a watering can that I've filled a bit too full and felt somethig tear in my upper back. I have to be quite careful - but I often forget and end up pulling something. I buggered up a tendon behind my knee 3 years ago just standing up on the pedals of a motorbike we were trying out . My husband and the showroom guy had to drag me off it. It was 9 months before I could go up and down stairs normally. Since then I have always got off our bike sidesaddle- luckily the seat is long enough but now my husband has to get off first as I could not bend my hip enough. I am hoping the surgeon will say I can get back on when I see him in April.
Life can be so hard at times. As we grow older we often feel our bodies are failing and putting a damper on our lives. Good luck with your next procedure.
Thank you. You are right. I still feel young in my head but find it hard to accept the mismatch of the decrepit body! But then dementia in a fit body would not be much fun either! On the whole I still enjoy my life - though the restaurants reopening would enhance it a lot.
I am fortunate to have an excellent GP. Normally my family and i can manage to get an appointment with our own GP so can get continuity of care and i find that extremely helpful. I recognise i am very fortunate with that.
As good as she is she is always ready to defer to the specialist and expects to put in place their recommendations. We both see it as a team effort in tandem with the relevant specialist and she is always willing to speak with my EP team when needed. That way i get rounded care and am grateful she doesnt impinge on the specialist expertise. Its a good team approach i am lucky enough to have.
You are indeed fortunate to get a continuity of care approach and many GPs and others recognise the value of such an approach in helping their patients. Sadly the growth of "Health Centres" with a broad range of services and Doctors this is more difficult to achieve. It is a situation that elderly patients find difficult to accept.In my experience it is all about trust and reassurance, consultants and specialists can seem remote and less interested in you as a patient, so getting reassurance from your GP is valuable.
I agree, getting the right professionals in our corner is key. There are eight doctors in my practice, four men, four women, all partners with a high patient number. They run a range of special clinics and have a whole new floor dedicated to training new GPs in their specialist GP training centre. They also work closely with a cohort of other surgeries in the district to share expertise and common best practice.
All doctors in my practice are partners and have a personal stake in their ‘business’. I think that is key to their success. We can choose to see whichever medic we want to but also have a named GP. They encourage patients to stick with one doctor to follow through with whatever medical issue we have consulted them with for continuity. However i have found through being a member of the patient participation group that their regular partner meetings ensures there is an overview of patients with multiple complex issues so no one has to start again with lengthy explanations if it is necessary to see another GP part way through or if we choose to or due to holiday cover etc.
I think the key to their success is that they are partners and not a practice owned externally by non contributing doctors or a conglomerate with salaried GPs.
You are so lucky. I see a different gp every time (if I am lucky enough to get an appointment) and I have a long complicated history which they often know nothing about. They only treat the bit that is actually in the acute stage at that time and never look at or know the whole picture.
I am sorry to hear you arent getting the medical support you deserve it is so unfair. I know of family and friends who like you have minimal support from their GPs and i feel so frustrated for everyone in that position. I have been with my GP practice for forty seven years and have had consistently good care throughout all that time. Is there a possibility you could look for another surgery.
Frankly I don’t think the only other surgery round here is any better from what I have heard. At least I know that if my A/fib becomes a lot worse (it is permanent now)the Royal Brompton will look after me. They even phoned me last year and reassured me that I am still their patient for which I am very grateful so in that respect I am lucky.
I agree with some of the points raised by all - my GP diagnosed my AF but called an ambulance as he was worried about stroke risk. Scared the wits out of me as he didn't explain anything. I'm certain that he felt the best way forward was for me to see a cardiologist, which happened the next morning.
Since then, my GP has been very supportive but I think he prefers a clinical expert to be in charge - as do I.
Regarding advising a poster to see a consultant - I think this is a good course under most circumstances, especially if the person is very symptomatic and appears to be 'stalled' in the system.
I agree with Badger's assessment of how some GP's see their role as gatekeepers or passers-on. Also sometimes there is too much reliance on modern electronics in preference to a good hands-on exam in the first instance.
Somehow, knowledge from the outset is the clue to good treatment but doctors don't have time, the patient is in shock at the diagnosis and don't know where to turn and facilities like this forum are in short supply.
Unfortunately not all doctors are equal, some will have the experience and competency to deal with your condition, others not so much. Of my 10 visits to A&E over a 23 year period on three occasions the doctors completely missed the issue and of the others they did not get it right.
One occasion the junior doctor was concerned and asked a more senior Dr for advice, this Dr asked my why I was in A&E with just a fast HR - I then explained to the Dr that the fast HR was not like the fast HR you get when exercising and described the symptoms (could not stand up without collapsing). Another 2 times the Docs told me it was anxiety/panic attack. It was not until the EP survey prior to an ablation that they identified the true cause which was MAT and the MAT had over the years had caused numerous other arrhythmia to form (AF Afl etc etc).
During the 24 years I had been suffering, incorrect diagnosis and treatment had deteriorated my condition and over this time had cost the NHS significant amounts. An early referral with the right treatment would have saved the NHS fortune and more importantly given me a much improved life.
Thankfully I now have my life back, the ablation, whilst not fully correcting the MAT did prevent the other arrhythmia returning, allowing me to lead a normal life. Consequently whilst I have empathy and desire for what you say, unfortunately it is not always the case on the ground. Intimate GP care we knew in a younger life has long been replaced by "Farmed" care which can be more efficient but not all.
You have to be lucky to get the correct diagnosis early. It can save you a life time of problems and the NHS a shed load of money. Unfortunately all too often the GPs and specialists get it wrong as in my case. What is more you get a good GP and he retires or moves away!
Welcome to the 21st century. The way GP’s work will be different across the UK but the clue is in the name, General Practitioner. If you believe there should be changes then probably better to write to the PM, Secretary of State for Health or your local MP.
You are very familiar with some of the highly detailed and complex papers relating to even small aspects of AF. These are often linked on this forum therefore it is obvious that no human being can absorb that degree of information for every ailment known to man. Given the reducing numbers of GP’s and increasing population, I think your vision of how the relationship between a GP and their patient should evolve in today’s world is probably fantasy, but time will tell.
This forum was set up to enable AF patients to exchange non-medical advice so I don’t think the current advice offered to seek a referral is likely to change any time soon.....
My GP, whom I trusted completely at that time, kept me under his care for whole year from diagnosis until I became persistent. Even when I said I was three days sinus and three days AF, he shrugged it off as it was the drugs working and this was rate control. Sure enough twelve days later I was persistent. Now the referral clock, in persistent, kept ticking to see an EP. This persistent waiting time was valuable. Also note, GPs cannot prescribe anti-arrhythmic drugs which limits their competency in treating AF patients, especially those, like myself, that quickly descend into persistent (again one year from diagnosis).
It is the stage in persistent that the heart really remodels. Mine remodelled so well in a bare six months that had I not gone out of country to get an ablation at the six month stage, I never would have been able to return to sinus. I should also add that I was under the care of this GP for thirty years, always healthy. The only thing I got was AF, and he failed me big time; so much for seeing "in the round."
Had I seen an EP early on it is most likely that I would have been properly treated not to become persistent , and to perhaps have one ablation rather than three with a totally burned and remodelled heart.
In terms of EP waiting time, maybe more of them would want to go into the field if there is a greater demand.
Right now, I am just coasting by going to a clinic. I have had enough of GP messing with my health. I would like to add a disclaimer: there are many excellent GPs who do wonders for their patients.
My conclusion is that if the episodes are very infrequent and short, by all means allow the GP to handle it. Any increase in frequency and duration, insist on a referral.
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